ITB Friction Syndrome


April is a great month to enjoy cycling and running, but with the pounding of running and the repetitive revolutions of cycling, our knees are at risk of developing Iliotibial band Friction Syndrome.

The ITB or Iliotibial band is a broad band of fascia (fibrous tissue) that runs from the outside of the hip to the outside of the knee, connecting a muscle called the tensor fascia lata to the knee.  ITBFS is an overuse injury that produces pain on the lateral knee or hip during running and, occasionally during cycling.  Pain is generally caused by an unusually tight ITB, the undersurface of which frictions over the boney prominences of the outside of the hip and knee.  This occurs during knee bending and straightening at approximately 30 degrees of knee bend.  When running and cycling, the tight ITB flicks over the boney prominence, causing friction, microtrauma, inflammation and pain.

Causes of ITBFS may be poor training habits, incorrect equipment or biomechanical imbalances.  Training habits such as running on a cambered surface, inadequate warm-up or cool down, excessive downhill running, or cycling with the foot toed-in can lead to pain.  Biomechanical issues such as overpronation, significant leg length differences, pelvic asymmetry, weak hip abductors or a tight ITB may contribute to the friction syndrome.  In the incidence of ITBFS from cycling, it is important to adjust the bike to fit the cyclist, rather than make the cyclist fit the bike.  Appropriate adjustments to the saddle, pedals and handlebars can alleviate the friction at the hip or the knee.

Treatment initially includes rest and control of inflammation with ice, anti-inflammatory medication and ultrasound or other physiotherapy techniques.  Further intervention then depends on correct diagnosis of the root cause of the problem.  This requires a thorough assessment and will ensure prevention and any recurrence of the problem.